Clinical Investigations: Acute Ischemic Heart DiseaseHow long is too long? Association of time delay to successful reperfusion and ventricular function outcome in acute myocardial infarction: The case for thrombolytic therapy before planned angioplasty for acute myocardial infarction☆,☆☆,★
Section snippets
Patient population
PACT was a multicenter, randomized, double-blind, placebo-controlled study in patients with an AMI that has been previously described in detail.16 Briefly, patient inclusion criteria included ischemic symptoms for ≥30 minutes, ST-segment elevation of ≥0.1 mV in ≥2 limb leads or ≥0.2 mV in ≥2 contiguous precordial leads, and MI symptoms for ≤6 hours. Patients were to have angiography as soon as possible after study drug (placebo vs 50-mg TPA) intravenous bolus administration. On arrival in the
Results
The baseline clinical and coronary angiographic characteristics of patients in the early and late reperfusion groups are described in Table I. ValuesEmpty Cell “Early reperfusion” “Late reperfusion” P Empty Cell (n = 37) (n = 241) Empty Cell Age 56 (48, 64) 57 (48, 65) .9 Male 76 84 .2 Diabetes 14 12 .6 Hypertension 43 36 .3 History of smoking 71 72 .9 Hypercholesterolemia 49 36 .06 History of angina 41 33 .2 History of MI 22 9 .02 History of CHF 1.6 0 .05 Anterior MI 24 35 .2 Multivessel CAD 67 49 .01
Discussion
The association of shortened times from symptom onset to treatment and mortality reduction in the setting of AMI has been demonstrated in multiple large clinical trials.1, 2, 3 This phenomenon was also demonstrated by the Myocardial Infarction Triage and Intervention Trial (MITIT) investigators4 and by Milavetz et al,6 with time to treatment expressed as a dichotomous variable (≤70 min vs >70 min and ≤2 h vs >2 h, respectively). The results of the present study confirm and extend these previous
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Cited by (28)
New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay
2013, Clinical BiochemistryCitation Excerpt :In particular, we have emphasized the relevance to report the effect of the time from symptom onset (time from ED presentation added of pre-hospital delay) on marker release. In fact, in these patients a wide body of literature has shown that the length of pre-hospital delay strongly affects morbidity and mortality rates and it is equally associated with successful reperfusion [16,21,22]. In addition, international guidelines recommend that reperfusion therapy should be performed within 90 min after the onset of symptoms [23].
Characterization of chemical composition of Agaricus brasiliensis polysaccharides and its effect on myocardial SOD activity, MDA and caspase-3 level in ischemia-reperfusion rats
2010, International Journal of Biological MacromoleculesPrehospital management of acute myocardial infarction. Data from a consecutive cohort of 115 patients in a french region in 2002
2005, Annales de Cardiologie et d'AngeiologieReperfusion in waiting: What queue should we join?
2002, American Heart JournalPrehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction
2007, European Journal of Cardiovascular Nursing
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Supported by a combined grant from Boehringer-Ingelheim, GmbH, Ingleheim, Germany, Boston Scientific, Natick, Mass, and Genentech, Inc, South San Francisco, Calif.
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Reprint requests: Conor F. Lundergan, MD, The Cardiovascular Research Institute, The George Washington University, 2150 Pennsylvania Ave NW, Suite 4-417, Washington, DC 20037.
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E-mail: [email protected]